Commercial Driver Application

Commercial Driver Application

Complete this form to apply for a commercial driving position with our company. Have your information ready.
Section 1: Applicant Information
Full Legal Name

First NameMiddle NameLast Name
Other Names Used (maiden name, aliases)
Date of Birth

MonthDayYear
Date
Social Security Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Position Applying For
Date Available to Start

MonthDayYear
Date
Referred By / How did you hear about us?
Are you legally eligible to work in the United States?
Are you at least 21 years of age (required for interstate commerce)?
Can you perform the essential functions of the job with or without reasonable accommodation?
Section 2: Address History (Past 3 Years - FMCSA Required)

FMCSA requires 3 years of residential address history. List your current and previous addresses.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dates at Current Address (From)

MonthDayYear
Date
Dates at Current Address (To)

MonthDayYear
Date
Previous Address #1

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dates at Previous Address #1 (From)

MonthDayYear
Date
Dates at Previous Address #1 (To)

MonthDayYear
Date
Previous Address #2

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dates at Previous Address #2 (From)

MonthDayYear
Date
Dates at Previous Address #2 (To)

MonthDayYear
Date
Section 3: Driver License Information
Driver's License Number
State of Issue
Class of License
Endorsements
Restrictions
Expiration Date

MonthDayYear
Date
Have you held a driver's license in any other state in the past 3 years?
If yes, list the states, license numbers, and dates
Section 4: License History & Qualifications
Has any license, permit, or privilege ever been suspended, revoked, denied, or cancelled?
If yes, provide details (date, state, reason)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Do you possess a valid Medical Examiner's Certificate (DOT Medical Card)?
Medical Card Expiration Date

MonthDayYear
Date
Do you have a current TWIC card?
Section 5: Experience and Qualifications
Total years of CDL driving experience
Class of equipment driven
Type of equipment
Approximate total miles driven (last 5 years)
States driven in
Special courses or training (defensive driving, hazmat, etc.)
Section 6: Accident Record (Past 3 Years - FMCSA Required)

Per 49 CFR 390.5, list all accidents in the past 3 years regardless of fault.
Have you had any accidents in the past 3 years?
Accident #1 Date

MonthDayYear
Date
Accident #1 Location and Nature
Accident #1 Number of Fatalities
Accident #1 Number of Injuries
Accident #1 Hazmat Spill?
Accident #2 Date

MonthDayYear
Date
Accident #2 Location and Nature
Accident #2 Number of Fatalities
Accident #2 Number of Injuries
Accident #2 Hazmat Spill?
Accident #3 Date

MonthDayYear
Date
Accident #3 Location and Nature
Accident #3 Number of Fatalities
Accident #3 Number of Injuries
Accident #3 Hazmat Spill?
Section 4: License History & Qualifications
Has any license, permit, or privilege ever been suspended, revoked, denied, or cancelled?
If yes, provide details (date, state, reason)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Do you possess a valid Medical Examiner's Certificate (DOT Medical Card)?
Medical Card Expiration Date

MonthDayYear
Date
Do you have a current TWIC card?
Section 7: Traffic Violations (Past 3 Years - FMCSA Required)

List all traffic violations other than parking violations.
Have you been convicted of any traffic violations (other than parking) in the past 3 years?
Violation #1 Date

MonthDayYear
Date
Violation #1 Charge
Violation #1 Location
Violation #1 Penalty
Violation #2 Date

MonthDayYear
Date
Violation #2 Charge
Violation #2 Location
Violation #2 Penalty
Violation #3 Date

MonthDayYear
Date
Violation #3 Charge
Violation #3 Location
Violation #3 Penalty
Have you ever been convicted of DUI/DWI?
Have you ever been convicted of a felony?
Section 8: Employment History (Past 10 Years - FMCSA Required)

FMCSA requires 10 years of employment history for DOT-regulated positions and 3 years for general employment. List all employers in chronological order, most recent first.
Employer #1 Company Name
Employer #1 Company Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer #1 Company Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer #1 Supervisor Name
Employer #1 Position Held
Employer #1 Employment Start Date

MonthDayYear
Date
Employer #1 Employment End Date

MonthDayYear
Date
Employer #1 Reason for Leaving
Was Employer #1 position subject to FMCSA regulations?
Was Employer #1 position subject to DOT drug & alcohol testing per 49 CFR Part 40?
May we contact Employer #1?
Employer #2 Company Name
Employer #2 Company Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer #2 Company Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer #2 Supervisor Name
Employer #2 Position Held
Employer #2 Employment Start Date

MonthDayYear
Date
Employer #2 Employment End Date

MonthDayYear
Date
Employer #2 Reason for Leaving
Was Employer #2 position subject to FMCSA regulations?
Was Employer #2 position subject to DOT drug & alcohol testing per 49 CFR Part 40?
May we contact Employer #2?
Employer #3 Company Name
Employer #3 Company Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer #3 Company Phone
Please enter a valid phone number.Format: (000) 000-0000.
Employer #3 Supervisor Name
Employer #3 Position Held
Employer #3 Employment Start Date

MonthDayYear
Date
Employer #3 Employment End Date

MonthDayYear
Date
Employer #3 Reason for Leaving
Was Employer #3 position subject to FMCSA regulations?
Was Employer #3 position subject to DOT drug & alcohol testing per 49 CFR Part 40?
May we contact Employer #3?
Section 8 (cont.): Employment Gaps
Are there any periods of unemployment in the past 10 years?
If yes, list the dates and reasons
Section 9: Drug and Alcohol Testing History (49 CFR Part 40)
In the past 3 years, have you tested positive or refused to test on any pre-employment drug or alcohol test required by DOT regulations?
If yes, have you successfully completed the DOT return-to-duty process per 49 CFR Part 40?
Provide documentation details if applicable
Section 10: Military Service
Have you served in the U.S. Armed Forces?
Branch
Dates of Service
Rank at Discharge
Type of Discharge
Section 11: References

Provide three professional references.
Reference #1 Full Name
Reference #1 Relationship
Reference #1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #1 Email
example@example.com
Reference #2 Full Name
Reference #2 Relationship
Reference #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 Email
example@example.com
Reference #3 Full Name
Reference #3 Relationship
Reference #3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3 Email
example@example.com
Section 12: Required Certifications and Authorizations

Please read each statement carefully and check the box to acknowledge and authorize.
Applicant Certification I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I understand that false or misleading information given in my application or interview(s) may result in discharge or denial of employment.
I certify the above statement is true and complete
PSP/MVR Disclosure and Authorization I authorize the company to obtain my Motor Vehicle Record (MVR), Pre-Employment Screening Program (PSP) report from FMCSA, and any other driving records from state and federal agencies as part of the pre-employment screening process.
I authorize the release and review of my MVR and PSP records
Previous Employer Investigation Consent (49 CFR 391.23) I authorize the release of information from my previous DOT-regulated employers regarding: (a) general driver employment verification, (b) accident record per 49 CFR 390.5, and (c) drug and alcohol testing history per 49 CFR Part 40, including any positive drug or alcohol tests, refusals to test, and completion of return-to-duty process within the past 3 years.
I consent to previous employer investigation per 49 CFR 391.23
Fair Credit Reporting Act (FCRA) Disclosure I acknowledge receipt of disclosure that consumer reports may be obtained for employment purposes.
I acknowledge the FCRA disclosure
Drug and Alcohol Testing Acknowledgment I understand that this position requires participation in a DOT drug and alcohol testing program, including pre-employment, random, post-accident, reasonable suspicion, return-to-duty, and follow-up testing.
I acknowledge the drug and alcohol testing program requirements
Applicant Signature
Print Full Name
Date of Signature

MonthDayYear
Date
Should be Empty:

Commercial Driver Application

Section 1: Applicant Information

Section 2: Address History (Past 3 Years - FMCSA Required)

Section 3: Driver License Information

Section 4: License History & Qualifications

Section 5: Experience and Qualifications

Section 6: Accident Record (Past 3 Years - FMCSA Required)

Section 4: License History & Qualifications

Section 7: Traffic Violations (Past 3 Years - FMCSA Required)

Section 8: Employment History (Past 10 Years - FMCSA Required)

Section 8 (cont.): Employment Gaps

Section 9: Drug and Alcohol Testing History (49 CFR Part 40)

Section 10: Military Service

Section 11: References

Section 12: Required Certifications and Authorizations